Chien W W, Scheinman M M, Cohen T J, Lesh M D
Department of Medicine, University of California, San Francisco.
Pacing Clin Electrophysiol. 1992 Jul;15(7):1015-24. doi: 10.1111/j.1540-8159.1992.tb03095.x.
Eight of 120 consecutive patients with inducible sustained ventricular tachycardia who were studied at our institution from September 1, 1988 to January 1, 1991, were found to have reentry within the His-Purkinje System as the mechanism of their tachycardias. Two of the eight patients (25%) required the recording of the right bundle branch potential to elucidate the tachycardia circuits. The electrophysiological findings of these two patients are described. In both instances, the diagnosis of supraventricular tachycardia with aberrancy was excluded. In patient 1, a His-bundle electrogram preceded each QRS complex during tachycardia and the His-to-His interval variation preceded changes in QRS intervals. However, recordings from the right bundle branch allowed for exclusion of bundle branch reentry and evidence was found for reentry restricted to the left fascicles. In patient 2, despite instances of dissociation of the His-bundle deflection from the tachycardia, a right bundle branch potential preceded each QRS and spontaneous changes in the interval between successive activation of the right bundle branch preceded changes in ventricular activation. Catheter ablation of the right bundle branch eliminated the tachycardia. It is concluded that the recording of a right bundle branch potential should be included in electrophysiology study of patients in whom there is suspicion of reentry within the His-Purkinje System. Clinically, recognizing these forms of tachycardias can be important because they can be effectively treated with catheter ablation.
1988年9月1日至1991年1月1日期间，在我们机构接受研究的120例持续性可诱导室性心动过速患者中，有8例被发现其心动过速机制为希氏-浦肯野系统内折返。这8例患者中有2例（25%）需要记录右束支电位以阐明心动过速环路。描述了这2例患者的电生理检查结果。在这两例中，均排除了伴有差异性传导的室上性心动过速诊断。在患者1中，心动过速时希氏束电图先于每个QRS波群，希氏束间期变化先于QRS间期变化。然而，右束支记录排除了束支折返，并发现折返局限于左束支的证据。在患者2中，尽管希氏束波与心动过速有分离情况，但右束支电位先于每个QRS波，右束支连续激动间期的自发变化先于心室激动变化。右束支导管消融消除了心动过速。得出的结论是，对于怀疑希氏-浦肯野系统内有折返的患者，电生理检查应包括记录右束支电位。临床上，认识这些形式的心动过速很重要，因为它们可通过导管消融有效治疗。
